Oh Moon Young, Yoon Kyung Chul, Kong Hyoun-Joong, Jang Taesoo, Choi Yeonjin, Kim Junki, Kim Jae-Yoon, Choi YoungRok, Chai Young Jun
Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
Department of Transdisciplinary Medicine, Institute of Convergence Medicine with Innovative Technology, Seoul National University Hospital, Seoul, Korea.
Ann Surg Treat Res. 2025 Jul;109(1):44-52. doi: 10.4174/astr.2025.109.1.44. Epub 2025 Jul 2.
Accurate anatomical knowledge and precise visualization are critical during liver surgery. We developed augmented reality (AR) software that overlays digital 3-dimensional (3D) models onto laparoscopic or robotic views, providing real-time visual aids for surgical navigation during 3D laparoscopic and robotic liver surgeries. This study assesses the accuracy of manual registration and the subjective perception of this AR software by the operator.
Ten consecutive patients undergoing 3D laparoscopic or robotic liver surgery from December 2023 to February 2024 were selected for application of the AR software during surgery. Manual registration accuracy was quantified post-registration using the Dice similarity coefficient (DSC) to compare the stereoscopic and virtual liver images. A 6-question operator survey, using a 5-point Likert scale, was administered after each surgery to evaluate the software's helpfulness in clinical settings.
Seven males and 3 females (mean age, 62.4 ± 6.4 years) underwent liver surgery (3D laparoscopic, 5; robotic, 5). Surgical procedures included 4 right hemihepatectomies, 1 extended left hemihepatectomy, 1 left lateral sectionectomy, and 4 segmentectomies. The mean tumor size was 4.4 ± 2.2 cm (range, 1.0-7.5 cm). The mean DSC was 0.912 ± 0.052 (range, 0.879-0.954). The operator rated registration alignment favorably before (mean score, 3.9 ± 1.1) and after mobilization (mean score, 4.1 ± 1.2). The software was reported as very helpful overall (mean score, 4.2 ± 0.8), and in locating blood vessels (4.2 ± 0.6) and tumors (4.3 ± 0.7).
Clinical application of the AR software during 3D laparoscopic and robotic liver surgery is feasible, with favorable registration accuracy and high operator perception of helpfulness.
在肝脏手术中，准确的解剖学知识和精确的可视化至关重要。我们开发了增强现实（AR）软件，可将数字三维（3D）模型叠加到腹腔镜或机器人视野上，为三维腹腔镜和机器人肝脏手术中的手术导航提供实时视觉辅助。本研究评估了手动配准的准确性以及操作者对该AR软件的主观感受。
选取2023年12月至2024年2月连续接受三维腹腔镜或机器人肝脏手术的10例患者，在手术过程中应用AR软件。使用骰子相似系数（DSC）在配准后量化手动配准的准确性，以比较立体肝脏图像和虚拟肝脏图像。每次手术后进行一项由6个问题组成的操作者调查，采用5分李克特量表，以评估该软件在临床环境中的帮助程度。
7例男性和3例女性（平均年龄62.4±6.4岁）接受了肝脏手术（三维腹腔镜手术5例，机器人手术5例）。手术方式包括4例右半肝切除术、1例扩大左半肝切除术、1例左外叶切除术和4例肝段切除术。平均肿瘤大小为4.4±2.2 cm（范围1.0 - 7.5 cm）。平均DSC为0.912±0.052（范围0.879 - 0.954）。操作者在肝脏游离前（平均得分3.9±1.1）和游离后（平均得分4.1±1.2）对配准对齐的评价良好。该软件总体上被认为非常有帮助（平均得分4.2±0.8），在定位血管（4.2±0.6）和肿瘤（4.3±0.7）方面也是如此。
AR软件在三维腹腔镜和机器人肝脏手术中的临床应用是可行的，配准准确性良好，操作者对其帮助程度评价较高。
